NCM 105 - CARE OF CLIENTS WITH MALADAPTIVE
PATTERNS OF BEHAVIOR
INSTRUCTION:
Please choose the correct answer. Color RED your chosen answer.
Add rationalization to your chosen answer and color it BLUE.
EATING DISORDERS
1. The Nurse is developing a plan of care for a female client
with anorexia nervosa. Which action should the nurse include in
the plan?
A. Provide privacy during meals
B. Set-up a strict eating plan for the client
C. Encourage client to exercise to reduce anxiety
D. Restrict visits with the family
• Establishing a consistent eating plan and monitoring
client’s weight are important to this disorder.
2. The Nurse is caring for a client diagnosed with bulimia. The
most appropriate initial goal for a client diagnosed with
bulimia is?
A. Encourage to avoid foods
B. Identify anxiety causing situations
C. Eat only three meals a day
D. Avoid shopping plenty of groceries
• Bulimia disorder generally is maladaptive coping response to
stress and underlying issues. The client should identify
anxiety causing situation that stimulate the bulimic
behavior and then learn new ways of coping with the anxiety
3. The Nurse is working in a mental health facility; the
nursepriority nursing intervention for a newly admitted client
withbulimia nervosa would be to?
A. Teach client to measure I & O
B. Involve client in planning daily meal
C. Observe client during meals
D. Monitor client continuously
• Measuring intake and output includes number of meals and
snacks per day, types and amount of foods and liquids
consumed and situations, when and where eating occurs. By
teaching the client proper measurements of intake and
output, they would be able to self-imposed calorie
Page 1 of 33
, restriction and dieting behaviour which is very important so
that they would be aware of their current situation. Also,
by doing such, the client will be more indulged to the
treatment process.
4. The Nurse is aware that the major health complication
associated with intractable anorexia nervosa would be?
A. Cardiac dysrhythmias resulting to cardiac arrest
B. Glucose intolerance resulting in protracted hypoglycemia
C. Endocrine imbalance causing cold amenorrhea
D. Decreased metabolism causing cold intolerance
• These clients have severely depleted levels of sodium and
potassium because of their starvation diet and energy
expenditure, these electrolytes are necessary for cardiac
functioning.
5. The Nurse is aware that the signs & symptoms that would be
most specific for diagnosis anorexia are?
A. Excessive weight loss, amenorrhea & abdominal distension
B. Slow pulse, 10% weight loss & alopecia
C. Compulsive behavior, excessive fears & nausea
D. Excessive activity, memory lapses & an increased pulse
• These are the major signs of anorexia nervosa. Weight loss
is excessive (15% of expected weight)
6. A characteristic that would suggest to a Nurse that an
adolescent may have bulimia would be:
A. Frequent regurgitation & re-swallowing of food
B. Previous history of gastritis
C. Badly stained teeth
D. Positive body image
• Dental enamel erosion occurs from repeated self-induced
vomiting and since client is bulimic, an attempt to avoid
gaining weight by purging what was consumed is most likely
to happen.
7. Which of the following is an example of all-or-nothing
thinking, which is a frequent cognitive distortion of patients
with an eating disorder?
A. “If I allow myself to gain weight, I’ll become immense.”
B. “I’m unpopular because I’m fat.”
C. “When I’m thin, I’m powerful.”
Page 2 of 33
, D. “When people say I look better, they’re really thinking I
look fat.”
• For clients struggling with bulimia and binge eating, this
is a common personality trait. Setting very high standards
for yourself personally, and then beating yourself up when
you don’t achieve them. Setting unrealistic, unachievable
goals, then failing to reach them and feeling rotten about
you.
8. Typical goals of inpatient hospitalization for an anorectic
patient do not include:
A. stabilization of the patient’s immediate condition.
B. limited weight restoration.
C. determination of the causes for the eating disorder.
D. restoration of normal electrolyte balance.
• An adequate outpatient eating disorder clinic needs to
provide individual psychotherapy with cognitive behavioral
techniques specific for anorexia nervosa and bulimia
nervosa, family therapy, pharmacological treatment and the
resources to obtain appropriate laboratory tests. Eating
disorder patients requiring inpatient care are best treated
in a specialized eating disorder inpatient unit.
9. Which patient with an eating disorder would be at greatest
risk for hypokalemia? A patient with:
A. anorexia who loses weight by restricting food intake.
B. anorexia or bulimia who purges to promote weight loss.
C. bulimia whose predominant pathological behavior is excessive
nocturnal eating.
D. an eating disorder who exercises intensely more than 4 hours
per day but maintains a normal electrolyte balance.
• The low frequency of hypokalemia in this group of eating
disordered outpatients suggests that routine electrolyte
determination is a poor screening tool for occult or denied
bulimia. Hypokalemia occurred almost invariably in lower-
weight bulimic (or anorectic/bulimic) patients who were
vomiting and/or abusing laxatives. Indeed, the study
suggests that hypokalemia in a patient with an eating
disorder is virtually certain evidence that the patient is
purging at least daily. In addition, it appears that a
patient with purely restricting anorexia nervosa is not at
risk for hypokalemia even if his or her weight is very low.
Page 3 of 33
, 10. Which medication is likely to be used in the treatment of
patients with eating disorders? An:
A. SSRI such as fluoxetine.
B. antipsychotic such as risperidone.
C. anxiolytic such as alprazolam.
D. anticonvulsant such as carbamazepine.
• Selective serotonin reuptake inhibitors (SSRIs) are the most
commonly prescribed antidepressants. They can ease symptoms
of moderate to severe depression, are relatively safe and
typically cause fewer side effects than other types of
antidepressants do.
11. Which of the following is least likely to contribute to
building an effective therapeutic alliance between the nurse and
an anorectic patient?
A. Establishing disciplined eating through the nurse’s
authoritarian approach with the patient
B. Avoiding the stance of a parental role in order to foster a
sense of empowerment
C. Offering a highly structured approach in treating severely
underweight patients
D. Contracting with the outpatient person about treatment terms
• Authoritarian approach style is exemplified when a leader
dictates policies and procedures, decides what goals are to
be achieved, and directs and controls all activities without
any meaningful participation by the subordinates. Such a
leader has full control of the team, leaving low autonomy
within the group. With this kind of approach to the client’s
with anorexia, the nurse and the client would be able to
have unity for their mutual benefit.
12. Which etiology for anorexia nervosa is from a neuroendocrine
perspective?
A. Anorexia nervosa is more common among sisters and mothers of
clients with the disorder than among the general population.
B. Dysfunction of the thalamus is implicated in the diagnosis
of anorexia nervosa.
C. There is a higher than expected frequency of mood disorders
among first-degree relatives of clients diagnosed with
anorexia nervosa.
D. Clients diagnosed with anorexia nervosa have elevated
Page 4 of 33
PATTERNS OF BEHAVIOR
INSTRUCTION:
Please choose the correct answer. Color RED your chosen answer.
Add rationalization to your chosen answer and color it BLUE.
EATING DISORDERS
1. The Nurse is developing a plan of care for a female client
with anorexia nervosa. Which action should the nurse include in
the plan?
A. Provide privacy during meals
B. Set-up a strict eating plan for the client
C. Encourage client to exercise to reduce anxiety
D. Restrict visits with the family
• Establishing a consistent eating plan and monitoring
client’s weight are important to this disorder.
2. The Nurse is caring for a client diagnosed with bulimia. The
most appropriate initial goal for a client diagnosed with
bulimia is?
A. Encourage to avoid foods
B. Identify anxiety causing situations
C. Eat only three meals a day
D. Avoid shopping plenty of groceries
• Bulimia disorder generally is maladaptive coping response to
stress and underlying issues. The client should identify
anxiety causing situation that stimulate the bulimic
behavior and then learn new ways of coping with the anxiety
3. The Nurse is working in a mental health facility; the
nursepriority nursing intervention for a newly admitted client
withbulimia nervosa would be to?
A. Teach client to measure I & O
B. Involve client in planning daily meal
C. Observe client during meals
D. Monitor client continuously
• Measuring intake and output includes number of meals and
snacks per day, types and amount of foods and liquids
consumed and situations, when and where eating occurs. By
teaching the client proper measurements of intake and
output, they would be able to self-imposed calorie
Page 1 of 33
, restriction and dieting behaviour which is very important so
that they would be aware of their current situation. Also,
by doing such, the client will be more indulged to the
treatment process.
4. The Nurse is aware that the major health complication
associated with intractable anorexia nervosa would be?
A. Cardiac dysrhythmias resulting to cardiac arrest
B. Glucose intolerance resulting in protracted hypoglycemia
C. Endocrine imbalance causing cold amenorrhea
D. Decreased metabolism causing cold intolerance
• These clients have severely depleted levels of sodium and
potassium because of their starvation diet and energy
expenditure, these electrolytes are necessary for cardiac
functioning.
5. The Nurse is aware that the signs & symptoms that would be
most specific for diagnosis anorexia are?
A. Excessive weight loss, amenorrhea & abdominal distension
B. Slow pulse, 10% weight loss & alopecia
C. Compulsive behavior, excessive fears & nausea
D. Excessive activity, memory lapses & an increased pulse
• These are the major signs of anorexia nervosa. Weight loss
is excessive (15% of expected weight)
6. A characteristic that would suggest to a Nurse that an
adolescent may have bulimia would be:
A. Frequent regurgitation & re-swallowing of food
B. Previous history of gastritis
C. Badly stained teeth
D. Positive body image
• Dental enamel erosion occurs from repeated self-induced
vomiting and since client is bulimic, an attempt to avoid
gaining weight by purging what was consumed is most likely
to happen.
7. Which of the following is an example of all-or-nothing
thinking, which is a frequent cognitive distortion of patients
with an eating disorder?
A. “If I allow myself to gain weight, I’ll become immense.”
B. “I’m unpopular because I’m fat.”
C. “When I’m thin, I’m powerful.”
Page 2 of 33
, D. “When people say I look better, they’re really thinking I
look fat.”
• For clients struggling with bulimia and binge eating, this
is a common personality trait. Setting very high standards
for yourself personally, and then beating yourself up when
you don’t achieve them. Setting unrealistic, unachievable
goals, then failing to reach them and feeling rotten about
you.
8. Typical goals of inpatient hospitalization for an anorectic
patient do not include:
A. stabilization of the patient’s immediate condition.
B. limited weight restoration.
C. determination of the causes for the eating disorder.
D. restoration of normal electrolyte balance.
• An adequate outpatient eating disorder clinic needs to
provide individual psychotherapy with cognitive behavioral
techniques specific for anorexia nervosa and bulimia
nervosa, family therapy, pharmacological treatment and the
resources to obtain appropriate laboratory tests. Eating
disorder patients requiring inpatient care are best treated
in a specialized eating disorder inpatient unit.
9. Which patient with an eating disorder would be at greatest
risk for hypokalemia? A patient with:
A. anorexia who loses weight by restricting food intake.
B. anorexia or bulimia who purges to promote weight loss.
C. bulimia whose predominant pathological behavior is excessive
nocturnal eating.
D. an eating disorder who exercises intensely more than 4 hours
per day but maintains a normal electrolyte balance.
• The low frequency of hypokalemia in this group of eating
disordered outpatients suggests that routine electrolyte
determination is a poor screening tool for occult or denied
bulimia. Hypokalemia occurred almost invariably in lower-
weight bulimic (or anorectic/bulimic) patients who were
vomiting and/or abusing laxatives. Indeed, the study
suggests that hypokalemia in a patient with an eating
disorder is virtually certain evidence that the patient is
purging at least daily. In addition, it appears that a
patient with purely restricting anorexia nervosa is not at
risk for hypokalemia even if his or her weight is very low.
Page 3 of 33
, 10. Which medication is likely to be used in the treatment of
patients with eating disorders? An:
A. SSRI such as fluoxetine.
B. antipsychotic such as risperidone.
C. anxiolytic such as alprazolam.
D. anticonvulsant such as carbamazepine.
• Selective serotonin reuptake inhibitors (SSRIs) are the most
commonly prescribed antidepressants. They can ease symptoms
of moderate to severe depression, are relatively safe and
typically cause fewer side effects than other types of
antidepressants do.
11. Which of the following is least likely to contribute to
building an effective therapeutic alliance between the nurse and
an anorectic patient?
A. Establishing disciplined eating through the nurse’s
authoritarian approach with the patient
B. Avoiding the stance of a parental role in order to foster a
sense of empowerment
C. Offering a highly structured approach in treating severely
underweight patients
D. Contracting with the outpatient person about treatment terms
• Authoritarian approach style is exemplified when a leader
dictates policies and procedures, decides what goals are to
be achieved, and directs and controls all activities without
any meaningful participation by the subordinates. Such a
leader has full control of the team, leaving low autonomy
within the group. With this kind of approach to the client’s
with anorexia, the nurse and the client would be able to
have unity for their mutual benefit.
12. Which etiology for anorexia nervosa is from a neuroendocrine
perspective?
A. Anorexia nervosa is more common among sisters and mothers of
clients with the disorder than among the general population.
B. Dysfunction of the thalamus is implicated in the diagnosis
of anorexia nervosa.
C. There is a higher than expected frequency of mood disorders
among first-degree relatives of clients diagnosed with
anorexia nervosa.
D. Clients diagnosed with anorexia nervosa have elevated
Page 4 of 33
